CPP Curiosities: Pick Your Poison: Historic Syphilis Treatments

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Greetings, fellow historico-medico aficionados and welcome to the triumphant return of CPP Curiosities, our semi-regular segment devoted to the medically weird. Kevin here to give you another tale of mildly-interesting medical miscellany. Past installments examined such topics as the iron lung, the preserved corpse of Vladimir Lenin, and that time President Grover Cleveland had a tumor removed during a secret surgery performed on a yacht.

Today’s installment is inspired by a presentation I recently delivered to visitors to the Mütter Museum on the subject of syphilis. Visitors that day got to see books related to the disease from our Historical Medical Library, including Corky the Killer, and handle reproductions of objects in our robust collection while learning about the history of the disease.

Youth Program Coordinator Kevin Impellizeri stands behind a table of specimens and books related to syphilis for a lesson at the Mütter Museum

Syphilis has been around for a long time. Today, it is treated through antibiotics; however, before the popularization of antibiotics in the 1940s, physicians attempted a wide variety of treatments, many of which were just as bad, if not worse, than the disease itself.

Let’s start by with a brief introduction to syphilis. Syphilis aka “the French Disease” aka “the Polish Disease” aka “the German Disease” aka “the Spanish Disease” aka “the Christian Disease”  is caused by the treponema pallidum bacteria and is spread through skin-to-skin contact with syphilitic lesions, usually during sexual contact. There are a few conflicting theories of where its specific origins lie, although there appears to be some consensus that it evolved as a strain of one of several other bone/skin conditions such as yaws or pinta. The earliest outbreak that is attributed to syphilis in Europe took place in Naples in 1494/1495, and there are some who argue the first strains of the disease came to the Continent aboard Christopher Columbus’ return trip from the New World in 1493.

The disease generally follows a four-stage pattern. The first, aptly named primary syphilis, is characterized by the appearance of a large sore known as a chancre at the site of infection. Aside from being unsightly, patients with primary syphilis don’t feel any discomfort and the chancre will go away on its own after about three to six weeks. During the second stage, again aptly named secondary syphilis, the infected patient will generally have a rash or skin lesions and can also exhibit symptoms similar to the flu such as fever, sore throat, swollen lymph nodes, muscle aches, and fatigue. Secondary syphilis has also been known to cause hair loss. As with its chancrous predecessor, these symptoms will go away on their own after a few weeks after which the disease enters its latent phase (which, you guessed it, is called latent syphilis) where a patient exhibits no outward symptoms. Syphilis can lie dormant in a person’s system for up to thirty years!

When syphilis reawakens after its latent stage is when the real health problems begin. During the syphilis’ final form, known as tertiary syphilis, the disease beings to attack the body, particularly the skin and skeleton. Syphilis causes bone and skin to deteriorate, leaving disfiguring lesions on the patient’s face. Tertiary syphilis can also spread to other organ systems, such as the eyes (ocular syphilis) or brain (neurosyphilis).

Wax model of a syphilitic face

Wax model of a syphilitic face

Historic treatments were often just as bad, if not worse, for a syphilitic patient than the disease itself. Mercury was the most popular treatment for syphilis before the twentieth century; mercury treatments gave birth to a common phrase associated with the disease: “A night with Venus, a lifetime with Mercury.” According to the World Health Organization, prolonged exposure to mercury can lead to respiratory, gastrointestinal, and neurological damage. In 1909, chemist Paul Ehlich developed an alternative to mercury therapy: Compound 606 aka Salvarsan. Named because it was the 606th trial chemical, Salvarsan is generally acknowledged as the first modern chemotherapy treatment, and Elrich went on to become the co-winner of the 1908 Nobel Prize in Physiology or Medicine. While considered effective in mitigating the early symptoms of syphilis, Salvarsan introduced another potentially deadly treatment: it was chock full of arsenic. According to the WHO, short term exposure to arsenic can cause vomiting, abdominal pain, diarrhea, numbness, and (depending on the level of exposure) death. Long-term exposure has been linked to skin, lung, and bladder cancers (long-time readers will recall arsenic was a suspected killer of President Zachary Taylor, although this was later disproven following an autopsy). Elrich eventually developed a replacement for Salvarsan, the creatively-named Neosalvarsan aka Compound 914, which contained slightly less arsenic; Neosalvarsan was the predominant treatment until the 1940s.

Skull with Syphilitic Necrotic

Skull with Syphilitic Necrosis, Mütter Museum, 1161.07

During the 1920s, Austrian psychiatrist Julius Wagner-Juaregg developed a novel approach to treating syphilis: infecting people with malaria. Malariotherapy is a branch of treatments that involves battling infection by inducing a high body temperature, a treatment generally known as pyrotherapy or fever therapy. Malaria is a potentially-useful pyrotherapy tool as it causes a high fever (in addition to chills, sweating, and body aches) and is curable with quinine. Wagner-Juaregg injected late-stage syphilitic patients with malaria and observed the parasite-induced fever’s efficacy in treating neurosyphilis. For his efforts, Wagner-Juaregg earned the 1927 Nobel Prize for Physiology and Medicine. Despite sounding like something a mad scientist might suggest, malariotherapy became a fairly common treatment for syphilis well through the 1950s. However, modern scientists have been divided as to its efficacy, citing in part Wagner-Juaregg’s ethically-questionable use of institutionalized patients. Incidentally, in more recent years, malariotherapy has been proposed as a treatment for HIV (see here and here) and (in at least one ill-advised instance of self-administered malariotherapy) Lyme Disease.

Fortunately, syphilis is easily treatable today with penicillin, which, although penicillin allergies are not uncommon, does not cause the severe long-term health repercussions of its heavy-metal predecessors. Also, using protection, such as condoms, during sexual intercourse can also prevent the spread of syphilis.

 

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Poison Control Experts Challenge the Karabots Junior Fellows

Students in the Krabots Junior Fellows Program speak with Robb Bassett, Interim Director of the Poison Control Center at Children's Hospital of Philadelphia

Challenge videos are all the rage on YouTube, from the “Cinnamon Challenge” (where one tries to eat a tablespoon of cinnamon without any liquid) to the “Chubby Bunny Challenge” (where a person tries to stuff as many marshmallows into their mouth and say, “Chubby Bunny”) to the “Ghost Pepper Challenge” (where a person eats a ghost pepper, one of the spiciest peppers on Earth). Searches on YouTube will find a plethora of videos of these and similar challenges, with different YouTubers competing to create the most audacious or entertaining video.

Recently students in the Karabots Junior Fellows learned about the potential health risks of these challenges from a pair of experts. Robb Bassett, DO, FAAEM, FCPP and Steven Walsh, MD, who, in addition to serving as Fellows of the College of Physicians of Philadelphia, are both experts when it comes to medical emergencies. Dr. Bassett is the interim Medical Director of the Poison Control Center at the Children’s Hospital of Philadelphia while Dr. Walsh is the attending physician in the Department of Emergency Medicine at Einstein Medical Center. The pair took the students through several popular YouTube challenges, explaining their possible health risks. For example, the Cinnamon Challenge, according to a 2013 report in the medical journal Pediatrics, can cause aspiration, pulmonary inflammation or even permanent respiratory damage; the effects can be exacerbated in people with asthma.

Robb Bassett, Interim Director of the Poison Control Center at Children's Hospital of Philadelphia, shows a PowerPoint slide on counterfeit drugs to students in the Karabots Junior Fellows Program

They used this as a way to segue into a talk about the risks of counterfeit recreational or prescription drugs. Did you know that, when formed into a pill, rat poison can be made to resemble prescription painkillers like Oxycontin? Bassett and Walsh explained the hazards of counterfeit drugs, while the students asked them a variety of questions related to their fields, YouTube challenges, and the ethics of treating different kinds of patients in emergency situations. Overall it was an engaging talk where many of the students shared their opinions and gained new knowledge.